Prescriber Opinions on Biosimilars in Immunology

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A high proportion of all surveyed physicians indicated that they prescribed biosimilars to their immunology patients in 2019 with biosimilars experiencing greater use in cost-conscious healthcare systems in Europe. The primary reason that all patients do not receive a biosimilar was due to patients’ doubts over the biosimilar’s efficacy. As such, the main factor that might encourage increased prescribing of biosimilars is the availability of real-world data for biosimilars in each country where they are being used. The use of biosimilars in originator naïve and treatment-experienced patients mirrors the position in the treatment algorithm where their reference products are typically used in autoimmune diseases.

The most frequently selected initiative that physicians believe would encourage biosimilar use is physician and patient education on the use of biosimilars. Expectations for future biosimilar usage in the next five years differed significantly by market, with respondents in the US and India particularly optimistic that use will increase. When questioned on reimbursement and whether a trial was necessary for their country for each indication versus data being extrapolated to all indications, physicians were divided in their replies. A significant number of respondents replied that they were unsure, suggesting a lack of physician understanding of payer decisions. Unsurprisingly, US respondents noted that insurance companies influenced the decision on whether to allow indication extrapolation. 

Infliximab biosimilars experience greater usage in cost-conscious healthcare systems in Europe compared with the US, while surveyed prescribers in Japan and India indicate proportional use of the reference product, Remicade (infliximab) versus infliximab biosimilars. Out of all surveyed markets, UK respondents indicated the greatest uptake of etanercept biosimilars, with the majority of patients receiving a biosimilar version over the branded originator product, Enbrel (etanercept). In 2019, Humira (adalimumab) maintained moderate usage in Germany, Italy, and Spain despite the availability of adalimumab biosimilars, indicating strong brand loyalty within these EU countries. With various cost-containment measures in place to curb healthcare expenditure, France and UK physicians prescribe adalimumab biosimilars to a large proportion of patients receiving a biologic for their autoimmune disease.

What are the factors influencing the choice of prescribed biosimilar brands in the 8MM?

Combining all markets, the top factor for choosing a biosimilar brand is the percent discount, followed by manufacturer reputation and supply stability. When choices were ranked, these three emerged as the first, second, and third rankings, respectively. Individually, all markets showed the discount rate to be particularly important, but manufacturer reputation emerged higher in APAC, and co-pay support was important in the US. Notably, “co-pay support” was not offered as an option to select for respondents outside of the US.

When selecting ranked choices, the highest proportion of respondents selected percent discount as their most important factor when choosing a biosimilar brand. The second most important factor was split between manufacturer reputation and co-pay support. However, co-pay support was the most frequently selected factor, by more than 75% of respondents, regardless of ranking. Although ranked overall lower, decisions by the patient’s insurer also emerged as a frequent selection. Unsurprisingly, the manufacturers most frequently cited as being preferred by surveyed physicians have the most geographic reach for their products, have internationally recognized names, and are among the largest pharmaceutical companies worldwide. The price and quality of biosimilars were seen as roughly equally important factors in the top choices for preferred biosimilar manufacturers.

What are the key countries prescribing biosimilar medicines to immunology patients?

A high proportion of all surveyed respondents indicate that they prescribe biosimilar medicines to their immunology patients, with nearly all German respondents indicating that they prescribe at least one of the four available biosimilars to their autoimmune patients. This suggests a favorable perception of biosimilars in the German immunology market. For the majority of respondents who indicated that they do not prescribe the biosimilar option to all of their patients, the top two factors that might encourage increased prescribing of biosimilars was the availability of real-world data for the biosimilar from their country/region and a recommendation for the use of biosimilars in international or national guidelines. A notable proportion of respondents from France and India indicated that an established reputation of the biosimilar manufacturer was a key factor that would increase their prescribing of biosimilars.

Biosimilar medicines prescribed to immunology patients, by respondents (%), 8MM

Biosimilar medicines prescribed to immunology patients, by respondents (%), 8MM

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What is the price regulation for biosimilars across the 8MM?

Most of the US respondents indicated that biosimilar prices are set through free pricing. In Europe, biosimilar prices are set by a mixture of regulations. In France and Germany, responses suggest that price regulation is commonly based on the originator drug’s price or a defined below the originator product. In Italy, Spain, and the UK, biosimilar prices are typically based on tenders and negotiations. In Japan, biosimilar prices are predominantly regulated based on the originator drug’s price. Responses from physicians in Italy suggest there is significant regulation of biosimilar prices over biologics at the national level. A large majority of the UK physicians surveyed by GlobalData indicated that biosimilar pricing is regulated at both a national and regional level. In APAC, a significant proportion of respondents from Japan stated that the price of new biologics was regulated at a hospital level, while responses from physicians in India suggest a high level of involvement at all three levels in price regulation of biosimilars.

Biosimilar price regulation, by country (Regulated: based on the price of the originator/defined % below the originator)

Biosimilar price regulation, by country

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Which companies are mentioned in the report?

Pfizer, Amgen, Merck/Biogen, Sandoz, Mylan, and Samsung Bioepis are some of the companies mentioned in the report.

Biosimilars in Immunology, by companies

Biosimilars in Immunology, by companies

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Market report scope

Base period 2021
Key biosimilar manufacturers Pfizer, Amgen, Merck/Biogen, Sandoz, Mylan, and Samsung Bioepis

Topics covered include Biosimilar Prescription Overview and Perception; Biosimilar Prescription Incentives or Disincentives; Price Regulation and Discounts; Biosimilar Reimbursement; Factors Influencing Choice of Prescribed Biosimilar Brands; Future Directions of Biosimilar Use

Key Highlights

Report deliverables include a PowerPoint report

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Table of Contents

1 Preface

1.1 Content

1.2 Abbreviations

1.3 Related Reports

2 Key Findings

3 Biosimilar Prescription Overview and Perception

3.1 Biosimilar Prescription Overview

3.2 Biosimilar Usage – Infliximab Versus Remicade

3.3 Biosimilar Usage – Etanercept Versus Enbrel

3.4 Biosimilar Usage – Adalimumab Versus Humira

3.5 Biosimilar Usage – Reasons for Not Prescribing Biosimilars to All Patients

3.6 Biosimilar Usage – Factors that Could Encourage Increased Use of Biosimilars

3.7 Biosimilar Prescriptions in Originator-Naïve Versus Treatment-Experienced Patients

3.8 Perception About Whether Biosimilars Are Cheap, Provide Cost Savings, and Increase Patient Access

4 Biosimilar Prescription Incentives and Disincentives

4.1 Incentives or Disincentives for Physicians to Prescribe Biosimilars

5 Price Regulation and Discounts

5.1 Price Regulation for New Biologics and Biosimilars

5.2 Price Regulation for Biosimilars Across the 8MM

5.3 Discounts Provided by Biosimilars Over the Originator Product’s Price

5.4 Discounts Needed for Physicians to Prescribe Biosimilars to >50% of Patients

6 Biosimilar Reimbursement

6.1 Biosimilar Reimbursement for All Indications Versus Select Indications

7 Factors Influencing Choice of Prescribed Biosimilar Brands

7.1 Factors Influencing Decisions on Prescribed Biosimilar Brands – 8MM

7.2 Factors Influencing Choice of Prescribed Biosimilar Brands – US

7.3 Factors Influencing Choice of Prescribed Biosimilar Brands – Preferred Manufacturers

8 Future Directions

8.1 Future Directions – Initiatives That Could Encourage Biosimilar Use

8.2 Future Directions – Predictions of Future Biosimilar Use in the Next Five Years

9 Appendix

9.1 Methodology

9.2 Primary Research − High-Prescribing Physician Survey

9.3 Primary Research − Biosimilars Experts (KOLs and Payers)

9.4 About the Authors

10 Contact Us

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